Department of Pharmacy, St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
J Pharm Pract. 2024 Aug;37(4):854-861. doi: 10.1177/08971900231189353. Epub 2023 Jul 12.
Opioid overdose deaths have increased over the last two decades, despite efforts to reduce prescribing. This study aimed to determine if a hospital-wide Alternatives to Opiates (ALTO) program reduced opioid prescribing in hospital and upon discharge after trauma. The primary outcome was incidence of opioid prescribing at hospital discharge Pre- and Post-ALTO. Secondary outcomes were the percent of patients with in-hospital opioid, non-opioid and multimodal analgesia, and hospital and intensive care unit (ICU) length of stay (LOS). This is a single-center, retrospective analysis of patients >/ = 18 years old admitted for >24 hours with the primary diagnosis of traumatic injury between August 2018 - October 2019. Patients with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. A total of 703 patients were included, 471 in Pre-ALTO and 232 in Post-ALTO groups. The mean age was 59 ± 22 years and most were male (58.7%). Mean initial Injury Severity Score (ISS) was 9.1 ± 7.7. Opioid prescribing at hospital discharge occurred more in the Post-ALTO group (132/332, 39.4% vs 90/203, 43.8%; = .1237). Most patients were prescribed in-hospital opioid (332/471, 70.4% vs 203/232, 87.5%, < .0001) and non-opioid (441/471, 93.6% vs 229/232, 98.7%; = .0027) analgesics, or multimodal analgesia (397/471, 84.3% vs 203/232, 87.5%; = .2591). Median hospital and ICU LOS were also similar between groups [5 (3-9) vs 4(3-7), = .3427] and ICU [2(0-4) vs 3(2-5), = .3461]. Opioids remain mainstay for trauma-related pain treatment. ALTO was not associated with less in-hospital or discharge opioid prescribing.
尽管已经采取了减少处方的措施，但在过去的二十年中，阿片类药物过量死亡的人数仍在增加。本研究旨在确定医院范围内的阿片类药物替代方案（ALTO）是否会减少创伤后住院期间和出院时的阿片类药物处方。主要结局是在 ALTO 前后医院出院时开具阿片类药物的发生率。次要结局是住院期间开具阿片类药物、非阿片类药物和多模式镇痛的患者比例，以及医院和重症监护病房（ICU）的住院时间（LOS）。这是一项单中心回顾性分析，纳入了 2018 年 8 月至 2019 年 10 月期间因主要诊断为创伤性损伤而住院时间超过 24 小时的年龄大于等于 18 岁的患者。排除了酒精或多物质滥用、慢性阿片类药物使用或院内死亡的患者。共有 703 名患者入组，其中 ALTO 前组 471 名，ALTO 后组 232 名。平均年龄为 59 ± 22 岁，大多数为男性（58.7%）。平均初始损伤严重程度评分（ISS）为 9.1 ± 7.7。ALTO 后组出院时开具阿片类药物的患者更多（132/332，39.4%比 90/203，43.8%； =.1237）。大多数患者住院期间开具了阿片类药物（332/471，70.4%比 203/232，87.5%， <.0001）和非阿片类药物（441/471，93.6%比 229/232，98.7%； =.0027）镇痛药，或多模式镇痛（397/471，84.3%比 203/232，87.5%； =.2591）。两组之间的中位住院和 ICU LOS 也相似[5（3-9）比 4（3-7）， =.3427]和 ICU [2（0-4）比 3（2-5）， =.3461]。阿片类药物仍然是治疗创伤相关疼痛的主要药物。ALTO 与减少住院期间或出院时的阿片类药物处方无关。
